Provider Demographics
NPI:1740251735
Name:GRIFFIN, CHARLES D (ARNP)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:D
Last Name:GRIFFIN
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:C
Other - Middle Name:DANIEL
Other - Last Name:GRIFFIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ARNP
Mailing Address - Street 1:PO BOX 1327
Mailing Address - Street 2:
Mailing Address - City:LACONIA
Mailing Address - State:NH
Mailing Address - Zip Code:03247-1327
Mailing Address - Country:US
Mailing Address - Phone:603-524-3211
Mailing Address - Fax:603-527-7038
Practice Address - Street 1:14 MILL ST
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:NH
Practice Address - Zip Code:03220-4432
Practice Address - Country:US
Practice Address - Phone:603-267-7017
Practice Address - Fax:603-267-7560
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH048046-23-03363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30341058Medicaid
NH39400OtherHARVARD PILGRIM HLTHCARE
NV3558667OtherAETNA
NH4757398OtherCIGNA
NH791031OtherMVP
NH30341058Medicaid
NV3558667OtherAETNA